Our journey through a knowledge translation project

Abstract

Background: Physiotherapists often encounter ethical challenges in practice, including evolving practice requirements, complex funding structures, and waitlist management due to limited resources and increased demand. Decisions and processes regarding management of wait lists are associated with questions of fairness in priority setting and principles of procedural justice. However there is a lack of tailored guidance related to physiotherapy. Therefore, this project focused on developing and sharing knowledge about this topic with clinicians, within a knowledge translation framework. Purpose(s): We developed and translated knowledge about equity in access to physiotherapy services. The project included three components: a scoping review, in-depth interviews, and knowledge translation workshops. Method(s): In order to identify the problem and assess barriers to knowledge use within a local context, we followed steps of Graham and colleague's model of the knowledge creation cycle with participants from 3 sites of a university health center. We began with a scoping review of academic and grey literature related to access and utilization of care in rehabilitation services (entry point, frequency, duration, discharge), and then conducted in-depth interviews to explore experiences around this topic in outpatient physiotherapy departments, looking specifically at waitlist management. We then conducted workshops on the systemic/institutional influences and the management of waitlists at each site as a way to adapt knowledge to the local context and support innovation. To monitor knowledge use, participants filled out a post-workshop survey directly after the event, and then 3 months later. Result(s): The scoping review identified five themes: access to care, evidence based policy creation, transparency of policies, privatization of practice, and professional autonomy. Through the interviews, we identified that PTs have pressure emerging from two opposite forces influencing how they experience and address the waitlist: their sense of responsibilities (toward their patient, the waitlist, the community, their colleagues) and the power dynamics at play (team, administration, medical, 3rd party). Through the workshops, many participants noted the source of the wait list as systemic factors not amenable to resolution at the department level. Three months later, participants reported increased discussion about wait list management and some changes in practice. Conclusion(s): Through our journey in this knowledge translation project, we can draw some important lessons. Facilitators to the success of the project included support of the project by department management and current relevance of the topic as the staff feel acute pressure over waitlists. There were also barriers, such as the complexity of the project with its multiple components, and little time between knowledge creation and translation. As well, some participants were hesitant to engage in the workshop, perhaps from low expectations or feelings of helplessness surrounding the daunting waitlist issue. Implications: This knowledge translation initiative used mixed methods to address an important issue in physiotherapy and led to modest but innovative changes with potentially improved access to physiotherapy. While this was the first step to identify and support the implementation of creative solutions, further work is needed to ensure all steps of the knowledge creation cycle are addressed.